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Washington rates for HCPCS B4152

Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.66 / $1.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.38 / $0.40 / $0.56
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.40 / $0.55 / $0.81
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.37 / $0.37 / $0.37
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.50 / $0.93
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.76 / $1.23
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.59